tbuckley/cabot-search huggingface dataset:
Abstract 11172: Heterogeneity in the Association Between the Presence of Coronary Artery Calcium and Cardiovascular Events: Multi-Ethnic Study of Atherosclerosis
Authors: Kosuke Inoue, Teresa Seeman, Tamara B Horwich, Matthew Budoff, Karol E Watson
Journal: Circulation (2022)

Introduction: Coronary artery calcium (CAC) has been widely recognized as an important predictor of cardiovascular disease (CVD). Given the finite resources, it is important to identify individuals who would receive the most benefit from detecting positive CAC by screening. However, the evidence is limited as to whether the burden of positive CAC on CVD differs by multi-dimensional individual characteristics. We aimed to investigate the heterogeneity in the association between positive CAC and incident CVD. Methods: This longitudinal cohort study included adults aged ≥45 years free of cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA). After propensity score matching in a 1:1 ratio, we applied a machine-learning causal forest model to (i) evaluate the heterogeneity in the association between positive CAC and incident CVD and (ii) predict the increase in CVD risk at 10-year when CAC&gt;0 (vs. CAC=0) at the individual level. We then compared the estimated increase in CVD risk when CAC&gt;0 to the 10-year atherosclerotic CVD (ASCVD) risk calculated by the 2013 ACC/AHA pooled cohort equations. Results: Across 3,348 adults in our propensity score-matched analysis, our causal forest model showed heterogeneity in the association between CAC&gt;0 and incident CVD. We found a dose-response relationship of the estimated increase in CVD risk when CAC&gt;0 with higher calculated 10-year ASCVD risk ( Figure ). Even among 1,413 adults with low/borderline ASCVD risk, 689 (49.4%) showed ≥7.5% increase in CVD risk when CAC&gt;0; these individuals were more likely to be male, non-Hispanic Black or Hispanic, less educated, never smokers, and have unfavorable CVD risk factors than others. Conclusion: The increases in CVD risk when CAC&gt;0 were heterogeneous across individuals, and nearly half of people with low/borderline calculated ASCVD risk showed a large increase in CVD risk when CAC&gt;0, highlighting the need for CAC screening among such low-risk individuals.
Abstract 12440: Type 2 Diabetes, Chronic Kidney Disease, and Major Cardiovascular Events in Patients With Established Cardiovascular Disease
Authors: Lukas Sprenger, Maximilian Maechler, Alexander Vonbank, Barbara Larcher, Arthur Mader, Andreas Leiherer, Axel Muendlein, Heinz Drexel, Christoph H Saely
Journal: Circulation (2022)

Introduction: Type 2 diabetes (T2DM) and chronic kidney disease (CKD) both confer a high risk of cardiovascular disease (CVD), and these conditions frequently coincide. The single and joint effects of T2DM and CKD on major cardiovascular events (MACE) in patients with established cardiovascular disease are unclear. Hypothesis: We hypothesize that T2DM and CKD are independent predictors of MACE in patients with established cardiovascular disease. Methods: We prospectively investigated 1738 patients with established cardiovascular disease - angiographically proven coronary artery disease (CAD) or sonographically proven peripheral artery disease (PAD) - over 10.0±4.7 years. Results: MACE occurred more frequently in T2DM patients (n=575) than in non-diabetic subjects (42.5% vs 29.8%, p&lt;0.001) and in patients with CKD (eGFR &lt;60ml/min/1.73m 2 ; n=302) than in those who did not have CKD (52.2% vs 30.1%, p&lt;0.001). When both, T2DM and CKD were considered, 996 subjects had neither T2DM nor CKD, 440 had T2DM but not CKD, 172 did not have diabetes but had CKD, and 130 had both T2DM and CKD. Compared to the incidence of MACE among patients with neither T2DM nor CKD (26.5%), MACE occurred more frequently in patients with T2DM who did not have CKD (38.2%; p&lt;0.001) as well as in non-diabetic patients with CKD (48.0%; p&lt;0.001); the incidence of MACE was highest in patients with both, T2DM and CKD (57.8%; p&lt;0.001), in whom it was higher than in those with T2DM but not CKD (p&lt;0.001) or those without T2DM but with CKD (p=0.007); the incidence of MACE was higher in non-diabetic CKD patients than in T2DM patients who did not have CKD (p=0.040). In Cox regression analysis, T2DM (HR=1.53 [1.29-1.83]; p&lt;0.001) and CKD (HR=1.85 [1.51-2.26]; p&lt;0.001) proved to be mutually independent predictors of MACE after adjustment for age, sex, BMI, hypertension, history of smoking, LDL-C, HDL-C and HbA1c. Conclusions: We conclude that T2DM and CKD in patients with established cardiovascular disease are mutually independent predictors of MACE. Cardiovascular disease patients with both CKD and T2DM are at an extremely high risk for MACE.
Abstract 11398: Prevalence and Characteristics of Systemic Inflammation in Adults With Atherosclerotic Cardiovascular Disease and Chronic Kidney Disease: Results From the National Health and Nutrition Examination Survey
Authors: Michael Nanna, Lance Sloan, Mads Faurby, Lise Lotte N Husemoen, Gamze Tombak, Deepak Yerragolam, Naveed Sattar
Journal: Circulation (2022)

Introduction: Systemic inflammation is linked to the development of atherosclerosis and the risk of major adverse cardiovascular events and mortality in adults with atherosclerotic CVD (ASCVD) and chronic kidney disease (CKD). Despite this, the epidemiology of systemic inflammation in this high-risk population has not been well described. Here, we estimate the prevalence of systemic inflammation in US adults with ASCVD with CKD, and characterize this population. Methods: Data were from the 2015-2020 pre-pandemic National Health and Nutrition Examination Survey (NHANES) cycles. Adults ≥ 20 years who completed the NHANES Medical Conditions Questionnaire and had non-missing serum creatinine and hsCRP levels, plus age, sex and ethnicity data, were included in this study. Systemic inflammation was defined as hsCRP ≥ 2 mg/L. To estimate prevalence in the US population, weighting was performed as outlined in the NHANES guidelines. Results: In total, 12 722 of 25 531 individuals met all the inclusion criteria. Based on weighted estimates, 8.4% of the general US population had ASCVD; of this group, 36.0% also had CKD and 22.1% had CKD stage 3/4. Systemic inflammation was present in 55.2% (95% CI, 49.8-60.6) of individuals with ASCVD, in 59.4% (53.4-65.2) with ASCVD and CKD, and in 62.1% (55.2-68.8) with ASCVD and CKD stage 3/4. The prevalence of individuals with systemic inflammation, ASCVD and CKD stage 3/4 among the US population was estimated at 1.2% (0.9-1.4). This group had a mean age of 72.1 years and a mean BMI of 31.9 kg/m 2 , 30.8% had type 2 diabetes and 38.9% had had an overnight hospital stay in the past 12 months ( Table ). A sensitivity analysis (patients with hsCRP 2-10 mg/L) had similar results. Conclusions: In this US survey, a large proportion of adults with ASCVD and CKD stage 3/4 had systemic inflammation. This group comprises an estimated 2.5 million adults who are likely to benefit from further targeted risk reduction efforts to help improve their cardiovascular outcomes.
Abstract 12434: ECG-Only Deep Learning Algorithm Predicts Risk of Arrhythmia in Phospholamban Cardiomyopathy
Authors: Rutger Van De Leur, Remco de Brouwer, Hidde Bleijendaal, Tom Verstraelen, Belend Mahmoud, Moniek Cox, Peter van Tintelen, Maarten van den Berg, Arthur Wilde, Pieter Doevendans, Rudolf A De Boer, Rene van Es
Journal: Circulation (2022)

Introduction Phospholamban (PLN) p.Arg14del mutation carriers are at risk of developing arrhythmogenic cardiomyopathy, but phenotypic penetrance is incomplete and much interpatient variability exists in the risk of malignant ventricular arrhythmias (MVA). Accurate risk stratification allows for timely device implantation which may prevent sudden cardiac death (SCD). The current prediction model is multimodal and uses data from ECG, echocardiography, MRI and 24-hour Holter monitoring. Hypothesis We hypothesized that a deep learning-based approach may allow for accurate risk prediction using only 12-lead ECG data. Methods A total of 679 PLN p.Arg14del mutation carriers without MVA at baseline were identified. MVA was defined as sustained VA, appropriate ICD intervention or (aborted) SCD. Prediction models were developed using Cox regression and validated using a bootstrap-based optimism corrected area under the receiver operating curve (AUC). A deep learning-based variational auto-encoder, trained on 1.1 million ECGs, was used to convert the median beat baseline ECG into its FactorECG. The FactorECG is a compressed version of the ECG which summarizes it into 21 explainable factors. Seven ECG factors that were previously shown to be associated with reduced ejection fraction were included in the model. A comparison to conventional ECG parameters and the current prediction model was performed. Results The deep learning-based ECG-only approach was able to predict MVA in PLN mutation carriers with an AUC of 0.82 [95% CI 0.78 - 0.86], comparable to the current multimodal prediction model (AUC 0.84 [95% CI 0.80 - 0.88]) and outperforming a model based on conventional ECG parameters (low voltage ECG and negative T waves; AUC 0.66 [95% CI 0.59 - 0.73]). Conclusions In conclusion, our deep learning-based algorithm uses only ECG data to accurately predict the occurrence of MVA in PLN mutation carriers, which could allow for easier stratification of patients at risk.
Abstract 12326: Heart Rate Variability According to Ambulatory Glucose Profile in Patients With Diabetes Mellitus
Authors: Sung I Im
Journal: Circulation (2022)

Introduction: Autonomic neuropathy commonly arises as a long-term complication in diabetes mellitus (DM) and can be diagnosed from heart rate variability (HRV), calculated from electrocardiogram (ECG) recordings. Hypothesis: There is limited data about HRV using real-time ECG and ambulatory glucose monitor in patients with diabetes mellitus Methods: Total of 43 patients (66.3±7.5 years) with DM underwent continuous real-time ECG monitor (225.7±107.3 hours) for HRV and ambulatory glucose monitor using remote monitoring system. And we compared HRV according to ambulatory glucose profile . Results: During the monitor, we checked total 15090 times of ECG and ambulatory glucose level simultaneously of all patients. Both time and frequency domain HRV were lower when the patients had poor controlled glucose level (&gt;200mg/dL) as compared with normally controlled glucose levels (&lt;200mg/dL) in Table. In addition, Heart rate and respiration rate increased according to real-time glucose level (P&lt;0.001). Conclusions: Poor controlled glucose level was independently associated with lower HRV in patients with DM. This is further substantiated by independent continuous associations between real-time measures of hyperglycemia and lower HRV. These data strongly suggest that cardiac autonomic dysfunction can be caused by elevated blood sugar alone.
Abstract 12656: Is the Benefit of Posterior Wall Isolation in Conjunction With Pulmonary Vein Isolation the Same for Patients With Paroxysmal vs. Persistent Atrial Fibrillation - A Meta-Analysis
Authors: Nicolle S Milstein, Dan L Musat, Advay G Bhatt, Mohammadali Habibi, Tina C Sichrovsky, Mark W Preminger, Richard E Shaw, Suneet Mittal
Journal: Circulation (2022)

Introduction: Pulmonary vein isolation (PVI) remains the cornerstone of atrial fibrillation (AF) ablation procedures. Because many patients have continued AF after PVI alone, posterior wall isolation (PWI) has been proposed as an adjunctive strategy to PVI. We conducted a meta-analysis of available data to assess the incremental impact of PWI based on whether patients had paroxysmal or persistent (PAF, PeAF) AF. Objective: To evaluate the incremental impact of PWI following PVI in patients with PAF and PeAF. Methods: The online databases (Pubmed, Medline, Embase) were searched using the terms “pulmonary vein isolation”, “posterior wall isolation”, or “posterior wall ablation”. Out of 1843 studies, 11 met our strict criteria (Table). Specifically, patients were undergoing de novo ablation for treatment of PAF or PeAF using either cryoballoon or radiofrequency energy. Patients had PVI +/- PWI; studies that included additional ablations (except for cavotricuspid isthmus ablation) were excluded. The primary outcome was long-term freedom from recurrence of any atrial tachyarrhythmia (AT). Results: The cohort consisted of 1702 patients (65 ± 18 years, 75% male); 1404 (82%) pts with PeAF and 298 (18%) pts with PAF (Table). In the PeAF group, AT recurrence was significantly higher in patients who underwent PVI alone as compared to those who also had PWI (OR 1.85, 95% CI [1.23, 2.77], P = 0.003, Figure). In contrast, in the PAF group, outcome was similar in patients who did and did not undergo PWI in addition to PVI (OR 0.95, 95% CI [0.53, 1.72], P = 0.86, Figure). Conclusions: PWI was rarely used during the de novo ablation procedure in PAF patients and did not seem to impart additional benefit. In contrast, PeAF patients seemed to derive favorable impact from the addition of PWI to PVI. Additional randomized studies are needed to determine the role of PWI in PeAF patient undergoing de novo ablation for management of AF.
Abstract 11191: Early Surgery versus Conservative Management Among Patients With Asymptomatic Aortic Stenosis: A Meta-Analysis
Authors: Vikash Jaiswal, Kriti Kalra, Abdelrahman Attia, Nida Khan, Amey Joshi, Abiram Baburaj, SWATIKA BUTEY, Nirmit Patel, Akash Jaiswal, Sidra Naz, Angela Ishak, Song Peng Ang, Jia Ee Chia, Chetana Pasam, Richa Mudwari
Journal: Circulation (2022)

Introduction: With the increasing prevalence of asymptomatic severe AS and its progression to the symptomatic stage the early surgical aortic valve repair is emerging as a popular option but with limited evidence of its efficacy and safety. Objective: We aimed to conduct a meta-analysis to evaluate the efficacy and safety to early surgical aortic valve repair as compared to conservative management. Methods: A systematic literature search was performed in PubMed, Scopus, Embase and Cochrane databases for studies comparing the early surgery versus conservative management among asymptomatic aortic stenosis patients. The primary outcome was all-cause mortality. Secondary endpoints were cardiovascular mortality (CVM), sudden cardiac death (SCD), hospitalisation due to heart failure, the composite of mortality and MACCE, Clinical thromboembolic events, major bleeding, myocardial infarction (MI), and stroke. Results: A total of 5 articles (3 observational studies and 2 randomized controlled trials) were included. We found that there were significantly lower odds of all-cause mortality [OR, 0.33; (95%CI:0.25-0.42); p&lt;0.000001], cardiovascular mortality [OR, 0.34 (95%CI:0.25-0.47); p&lt;0.00001] and composite of mortality and MACE (OR:0.32(95%CI:0.24,0.42;p&lt;0.00001), sudden cardiac death (OR:0.32; CI: 0.16-0.64; p=0.001) and hospitalization due to heart failure (OR:0.27, CI: 0.16-0.44; p&lt;0.00001) with early surgical aortic valve repair compared to conservative management. There was no significant difference between the incidence of major bleeding, clinical thromboembolic events, stroke and myocardial infarction between the conservative care groups and early surgery. We also found a reduced risk of Conclusion: Among asymptomatic patients with AS, SAVR shows better outcomes in reducing mortality and other complications compared with the conservative management approach.
Abstract 12639: Perceived Social Support in Heart Failure Caregiving: A Convergent Mixed-Method Study
Authors: Angela Cuoco, Marco Di Nitto, Ahtisham Younas, Josiane Boyne, Raul Juarez-Vela, Ercole Vellone, Angela Durante
Journal: Circulation (2022)

Introduction: Caregivers play an instrumental role in ensuring adequate self-care for their relatives with heart failure (HF). Nevertheless, caregivers can be subject to negative outcomes and sacrifice of personal needs due to their challenging caregiving role, which increases the demand for social support. Previous studies did not provide a comprehensive understanding of perceived social support and its associated factors among caregivers of individuals with HF. Methods: A convergent mixed-methods approach was used. In total, 158 patients with heart failure and their informal caregivers completed validated scales to measure their perceived social support, mutuality, anxiety, depression, and quality of life (physical and mental dimensions). Semi-structured interviews were conducted with 50 caregivers. Multiple linear regression analysis was conducted to identify the predictors of perceived social support, and content analysis was performed on qualitative data. The results were merged using joint displays. Results: Caregivers had a mean age of 57 (14.4 SD) and gave their care to the patients for an average hours per week of 30.38 (28.28 SD). Patients with HF had a mean age of 73.74 (13.46 SD) mostly (48.7 %) in NYHA class II. Quantitative results showed that caregivers perceived better social support when they had a better mental quality of life and higher levels of mutuality. Likewise, when patients’ levels of mutuality were lower, caregivers felt less socially supported. Qualitative findings support that perceived social support was influenced by the caregiver’s mutuality, the patient’s involvement in self-care and the caregiver’ emotional state. Integration of quantitative and qualitative data confirmed that caregivers’ mutuality and emotional state influenced caregivers’ social support. Conclusions: Mental health status can affect caregivers’ ability to perceive social support. There is a need to develop and evaluate individual and community-based strategies to promote caregivers’ mental health for increasing their perceived sense of social support and community belonging. More dyadic strategies should be developed to improve caregiver-caregiver mutuality to increase the sense of support in the heart failure caregiving process.
Abstract 11164: Precise Genomic Correction of <i>RBM20</i> Mutations Rescues Dilated Cardiomyopathy
Authors: Takahiko Nishiyama, Yu Zhang, john mcanally, Lin Xu, Ning Liu, Rhonda S Bassel-duby, Eric N Olson
Journal: Circulation (2022)

Introduction: Despite current medical advancements, effective treatment for familial cardiomyopathies remains challenging. Mutations in RNA binding motif protein 20 ( RBM20 ) are a common cause of dilated cardiomyopathy (DCM). Many RBM20 mutations cluster within the arginine/serine rich (RS-rich) domain, which mediates nuclear localization. These mutations induce RBM20 mis-localization and abnormal alternative splicing of cardiac genes. Importantly, the formation of aberrant ribonucleoprotein (RNP) granules in the cytoplasm of cardiomyocytes may contribute to DCM. Hypothesis: Precise genomic editing using base editing (BE) or prime editing (PE) corrects the mutations and rescues the pathophysiology of RBM20-related DCM. Methods: We used adenine base editing (ABE) or PE to correct the pathogenic p.R634Q (c.1901 G&gt;A) and p.R636S (c.1906 C&gt;A) mutations in the RS-rich domain of RBM20 in human isogenic induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM). Additionally, using a humanized Rbm20 mutant mouse (R636Q/R636Q), we assessed in vivo ABE correction for DCM treatment. Results: Correcting RBM20 R634Q human iPSC by ABE using ABEmax-VRQR-SpCas9 and sgRNA components, we showed 89% efficiency of A to G editing, recovery of alternative splicing of cardiac genes, restoration of nuclear localization of RBM20 and elimination of RNP granule formation. Additionally, we developed a PE strategy to correct the RBM20 R636S mutation in iPSCs and observed A to C editing at 40% efficiency. To evaluate the potential of ABE for DCM treatment, we systemically delivered ABE components by adeno-associated virus in postnatal Rbm20 mutant mice (R636Q/R636Q). Uncorrected R636Q/R636Q mice exhibited severe heart failure and premature death by 3-months of age. In contrast, R636Q/R636Q mice receiving systemic ABE components showed a substantial improvement of LV function and an increase in life span. As seen by RNA-seq analysis, ABE correction rescued the transcriptional profile of treated R636Q/R636Q mice, while untreated mice showed altered cardiac gene expression. Conclusions: Precise gene editing technologies provide an innovative approach to correct disease-causing genomic mutations in cardiovascular diseases.
Abstract 11139: Role of Esophageal Cooling in the Prevention of Esophageal Injury in Atrial Fibrillation Catheter Ablation: A Systematic Review and Meta-Analysis of Randomized Controlled Studies
Authors: Mohamed Hamed, Sheref Elseidy, Mohamed Abdelsabour, Amr F Barakat, Ayman Elbadawi
Journal: Circulation (2022)

Introduction: Trials evaluating the role of esophageal cooling in the prevention of esophageal injury in patients undergoing atrial fibrillation (AF) catheter ablation have yielded mixed results. The aim of our study is to evaluate the efficacy of esophageal cooling in the prevention of esophageal injury in patients undergoing AF catheter ablation. Methods: Comprehensive search of MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) evaluating the role of esophageal cooling compared with control in the prevention of esophageal injury during AF catheter ablation. The study's primary outcome was the incidence of total esophageal injury. Secondary outcomes included the incidence of severe esophageal injury, the incidence of mild to moderate esophageal injury, procedural duration, posterior wall duration, total radiofrequency (RF) time, acute reconnection incidence, and ablation index. Results: The meta-analysis included 4 RCTs with total of 294 patients. There was no significant difference in the incidence of total esophageal injury between esophageal cooling and control (15% vs. 19%; Relative Risk [RR] 0.86; 95% confidence interval [CI] 0.31 - 2.41; I 2 = 63%). However, compared with control, esophageal cooling showed lower risk of severe esophageal injury (0.01% vs. 0.09%; RR 0.21; 95% CI 0.05 - 0.80). There were no significant differences among the two groups in mild to moderate esophageal injury (13.6% vs. 12.1%; RR 1.09; 95% CI 0.28 - 4.23), procedure duration (standardized mean difference [SMD] -0.03; 95% CI -0.36 - 0.30), posterior wall duration (SMD 0.27; 95% CI -0.04 - 0.58), total RF time (SMD -0.50; 95% CI -1.15 - 0.16), acute reconnection incidence (RR 0.93; 95% CI 0.02 - 36.34), and ablation index (SMD 0.16; 95% CI -0.33 - 0.66). Conclusions: Among patients undergoing AF catheter ablation, esophageal cooling did not show a significant difference in the incidence of total esophageal injury. However, it has shown a significant decrease in the risk of severe esophageal injury without affecting the ablation process. This can help decrease the progression to atrial-esophageal fistula. Further large RCTs are needed to better evaluate the role of esophageal cooling in the prevention of esophageal injury.